Q: How does one take care of her incision site after she has been discharged from hospital? When can water touch the site?

A: The duty of the patient in taking care of the incision site after discharge lies in NOT GETTING THE DRESSING WET. When the skin wound has completely closed and the wound dressing removed, it is alright for water to touch the site but DO NOT scrub the incision. You may use a mirror to inspect the incision to make sure the skin around it is not red, or that there is no fluid or pus draining from the wound; which are signs that you should go to the hospital. Make sure you wash your hands regularly. If you need to cough or sneeze, use your hands to support/ hold your abdomen (tummy) around the incision site to brace it before you cough. You may also hold a pillow over the incision.

If you are constipated, inform your doctor since you should not strain to stool. Avoid lifting any object heavier than your baby in the two weeks following your surgery. Eat a balanced diet with emphasis on protein and drink lots of water. Do not bend unduly. Wear loose clothing and waist high cotton underwear to avoid pressure or friction on the scar.

Q: What is the recovery period after a CS? How soon is it medically advisable to get pregnant?

A: You should be able to walk within 24 hours and even if it is painful, as long as the medical team do not advise against it, stand up and walk; because the sooner you get going the better for your circulation. This also means your urinary catheter can be removed. You generally will be able to start drinking fluids the day after surgery and providing you don’t vomit, eat the same day or a day after you start drinking.

You should be ready for discharge by the 3rd day after surgery as long as there are no complications. 2 weeks after a caesarean section you may find that you have healed (recovered) enough to carry on most activities with care. IT IS HOWEVER WISE TO WAIT TO GET CLEARANCE AFTER THE SIX WEEK POST DELIVERY CLINIC CHECK BEFORE TAKING ON MORE ACTIVITIES AND POSSIBLY RETURNING TO WORK. Generally speaking though, you should be fully healed 3 – 4 months after a caesarean section. YOU SHOULD GIVE YOUR BODY AT LEAST 12 MONTHS BEFORE GETTING PREGNANT, but will more than likely be offered another caesarean delivery if the time to the next pregnancy is short. IF YOU ARE HOPING TO ATTEMPT A VAGINAL BIRTH YOU MAY BE BETTER OFF WAITING AT LEAST 18 MONTHS. The longer your scar has to heal, the better.

Q: Why do the stitches still itch as long as six months to 1 year postpartum in some patients? What is the remedy for the itching?

A: Itching earlier on can be from the pubic hair that was shaved prior to the surgery which is growing again. Later, itching is considered a sign that the wound is healing. Be careful if you scratch since it is possible to hurt yourself. It is better to massage the scar with oil or cream (e.g. Shea butter, cocoa butter).

Q: Can a woman have a vaginal birth after a CS? (VBAC) or once you undergo CS, it would always be a CS?

A: YES, a woman can have a vaginal birth after a caesarean section as long as the reason for the previous c/s is a non recurrent one; and that in the present pregnancy, there is no contraindication to vaginal birth. E.g. placenta praevia, an abnormal position of the baby, or if the estimated weight of the present baby (unborn) is 4 kg or more, a vaginal birth will obviously be unlikely. Remember though that it is a trial of labour, which can be abandoned at any time when things appear to be going wrong. However, it is unlikely that a woman who has had 2 caesarean sections will be allowed an attempt at vaginal birth in this country and indeed most countries in the world.

Q: Is there a limit to the number of caesarean sections a woman can have?

A: Certainly. It is however difficult to put a figure to this limit. Whereas we may traditionally say that a woman can have 3 – 4 caesarean sections, it may be safer to say that the state of the uterus and the abdomen at the last surgery should determine whether a woman should undertake another pregnancy or not. For example, has the wall of the uterus become too thin or will the adhesions in the abdomen present if any, safely allow for another surgery?

It is pertinent to note that the more caesarean sections a person has, the more technically challenging a subsequent c/s will be and also the more the likelihood of complications.

THE END….

Here’s a brief Profile:

Dr Uche Iwuh graduated from the school of medicine of the University of Benin in 1989.His postgraduate training in Obstetrics and Gynaecology was at the Lagos University Teaching Hospital. He holds a fellowship of the West African College of Surgeons in the faculty of Obstetrics and Gynaecology.He has a special interest in minimal access surgery and has attended several courses/trainings in Africa and Europe.He works as a consultant obstetrician/gynaecologist at the Premier Specialists Medical Centre in Victoria Island, Lagos.He is happily married with children.

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